Diagnostic approach at specialized syncope units in the netherlands: a cross-sectional, nationwide survey

Abstract

Abstract Introduction The European Society of Cardiology Guidelines recommend a structural approach for the initial evaluation of syncope patients, yet implementation of such approach appears cumbersome. There are several specialized Syncope Units in the Netherlands. Here we investigated the diagnostic strategy of specialized Syncope Units and adherence areas for syncope patients. Purpose We aimed to identify the current network of Syncope Units in the Netherlands and to assess to which extent the units fulfil requirements as indicated by the European Heart Rhythm Association consensus and the current guidelines. Methods All units Neurology, Internal Medicine, and Cardiology in hospitals in the Netherlands were contacted. Units with specialized Syncope care were included and requested to fill out a questionnaire of 25 questions regarding which medical specialties are involved during evaluation, which diagnostic tests are available and being performed and which adherence regions were associated. We specifically investigated whether the Syncope Units adhered to the consensus statements 1 and 3 as described by the European Heart Rhythm Association position paper as gold standard for best practices. Results Specialized care for syncope was reported in 20/72 hospitals. Most (17/20) reported that multiple specialties are involved during the initial evaluation. 19/20 had either Neurology, Cardiology, or both responsible for the Syncope Unit. 18/20 perform guideline-based orthostatic blood pressure measurement. A non-invasive-beat-to-beat blood pressure monitor was present in 11/20 units. 16/20 perform tilt table testing and do > 48 per year, 3/16 this was during the initial evaluation and 15/20 perform carotid sinus massage. The adherence areas cover 64.2% of the Netherlands. Both European Heart Rhythm Association consensus statements 1 and 3 for best practice were met in 4/20 of the Syncope Units, 4/20 only met consensus statement 1 and 14/20 only met consensus statement 3. Conclusion We identified 20 Syncope Units in the Netherlands. The diagnostic approach varies in the medical specialties involved, protocols for cardiovascular testing, and timing of diagnostic tests. Most units did not completely perform the Guideline suggested initial evaluation. Four out of 20 Syncope Units met the European Heart Rhythm Association consensus statements for best clinical practice.Overview Syncope Units NetherlandsAdherence of the Syncope Unit